For Some Vermonters Suffering From Hepatitis C, Life-Saving Cure Is Out Of Reach

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Denying patients access to something with such clear benefits is immoral, it’s illegal, and it shouldn’t be happening.” — Julia Shaw, health care policy analyst in the Office of the Health Care Advocate. While this story is from Vermont in the USA the same holds true for Canada. Canada’s policy restricting access is immoral and illegal.

Health advocates are challenging a Vermont Medicaid policy that has restricted curative treatment for hepatitis C only to patients with advanced liver problems. And while state officials say they’re open to changing the policy, they say offering treatment to all low-income Vermonters could cost taxpayers as much as $25 million over two years.

It’s been about two years since medical science delivered a cure for hepatitis C. The breakthrough has been a true lifesaver for patients who would have gone on to suffer severe liver disease, cancer, or other conditions caused by the virus.

But not everyone infected by hepatitis C has been lucky enough to get the expensive treatment. And patients like the one interviewed for this story have been left in a sort of medical limbo.

“I have grandchildren. I want to be around for my grandchildren. I don’t know. I don’t want it to be the disease that kills me,” says the patient.

Here’s the issue for the potentially hundreds of Medicaid beneficiaries like the Patient in this story: Doctors assess liver damage using what’s known as a Metavir fibrosis score. It basically measures the amount of scarring on the liver. And under Vermont Medicaid’s prior-authorization policy, beneficiaries don’t get the cure until they have a score of F3 or higher, which, according to Shaw, “basically requires a patient with Hepatitis C to have significant liver damage before they’re able to be treated.”

Dr. Raymond Chung is a hepatologist at Massachusetts General Hospital, where he directs the hepatology division and the liver center. He’s also a chairman on the guidance panel at the American Association of Liver Diseases. Chung says it isn’t only liver damage that hepatitis C patients need to worry about.

“There is evidence that hepatitis C can contribute to the risk of kidney disease, as well as the development of diabetes,” Chung says.